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Hand washing with soap has been shown to
reduce diarrhea and respiratory disease, the two leading
causes of childhood deaths in low- and middle-income
settings. Glo... Show More +bal scaling up hand washing was initiated in
2006 by the water and sanitation program (WSP) in Peru,
Senegal, Tanzania, and Vietnam. The hand washing promotion
interventions deployed in the global scaling up countries
were developed using a framework known as focus,
opportunity, ability, and motivation (FOAM). A hand washing
promotion intervention can only result in improved health or
other downstream benefits if it results in increased hand
washing behavior. In the impact evaluation of global scaling
up hand washing, hand washing is measured using
self-reports, rapid observations, and structured
observations, recognizing that each method provides useful
insights into awareness about hand washing, the availability
of materials necessary for hand washing, and the practice of
washing hands at critical times. Specifically, with respect
to the FOAM framework, this report addresses constructs
within the focus, opportunity, and ability domains. The goal
of this report is to describe hand washing behavior of
households included in the project impact evaluation, as
measured during the baseline surveys conducted in Peru,
Senegal, and Vietnam. The baseline surveys of global scaling
up hand washing indicate opportunities to improve hand
washing behavior in all of the countries where interventions
are being tested. In the future, correlations can be
described between measures and relationship with disease
risk and other hygiene behaviors in the home, including
sanitation and household water treatment. Show Less -

Papua New Guinea (PNG) has a population
of 6.9 million people, 87 percent of whom live in rural
environments. Access to improved water and sanitation has
been decli... Show More +ning in recent years and as a result PNG is not on
track to meet either the millennium development goals, or
its own national development targets of 70 percent access by
2030, and 100 percent access by 2050. This synthesis report
details the process and outcomes of water and sanitation
program (WSP) - World Bank technical assistance (TA) to
policy development support and capacity building, PNG water
sanitation and hygiene. The government of PNG has been
attempting to develop a national water and sanitation policy
since 2005. In 2008 the national executive council (NEC)
established a multi-agency task force for this purpose but
due to a lack of leadership it made little progress. An
early priority was to begin work on identifying a suitable
institutional framework and financing pathways for service
delivery and in February 2013 additional specialist TA was
provided to support this endeavor. TA assisted both the
Department of National Planning and Monitoring (DNPM) as
chair of the task force and the task force directly in order
to facilitate development of the policy. The overall
objective of the TA was to support the development of a
comprehensive draft water, sanitation, and hygiene (WasH)
policy for submission to the NEC. Show Less -

Open defecation within a community harms
the physical and cognitive development of children, even
children living in households that use toilets themselves.
Frequen... Show More +tly digesting feces due to poor sanitation can cause
diarrhea, malnutrition, and stunted growth-and thus impact
negatively on a child's cognitive development.
Experiencing these health hazards at young ages can
ultimately limit one's earning potential later in life.
In addition to the use of health services, mother and child
nutrition practices and care, the immediate disease
environment shapes early life health and ultimately a
child's achievement later in life. Thus, elimination of
open defecation makes a sensible priority for policy makers
that are concerned with the next productive generation. This
brief shows, the level of open defecation in a community is
associated with shorter children in Cambodia. Moreover, the
level of open defecation in a community is more important
for a child's development than whether the child's
household itself openly defecates. By looking at the change
in defecation levels and average child height between 2005
and 2010 within Cambodian provinces, the study is able to
show that improvements in sanitation access played a
substantial role in increasing average child height over the
same five years. Show Less -

The Economics of Sanitation Initiative
(ESI) of the World Bank's Water and Sanitation Program
(WSP) commenced in East Asia and the Pacific region in 2006
to generat... Show More +e and disseminate economic evidence on sanitation.
A phase one study in five countries of the region, including
Indonesia, assessed the economic costs of inadequate
sanitation to raise the profile of sanitation nationally. A
phase two study compared the costs with the benefits of a
range of sanitation intervention options in five physical
locations in Indonesia, to assist decision makers in their
choice of sanitation technology and delivery method. Since
the demonstrated successes of ESI in the East Asia and
Pacific region, ESI has become a global flagship program of
WSP. However, some economic benefits have not been fully
evaluated in monetary terms because of methodological
difficulties in valuing nonmarket impacts, the paucity of
underlying data sets, and the difficulties inherent in
attributing observed impacts to poor sanitation. Among these
hard-to-measure benefits are the impacts of poor sanitation
on water resources. Hence, the purpose of this study was to
develop and pilot test a specific methodology for valuing a
wider range of impacts related to water resource pollution
in Indonesia. Show Less -

Inadequate access to sanitation remains
a persistent issue, affecting the lives of millions of
children and families especially in poor and rural
communities throug... Show More +hout the world. In Indonesia, efforts to
expand coverage have barely affected the lives of poorest
populations where rampant diarrheal disease continues to
affect the health and well-being of the next generation of
children. These efforts were further complicated by policies
that provided sanitation hardware subsidies limited to
populations identified under specific programs, rather than
strategies aimed at promoting large-scale sustained behavior
change such as awareness building and hygiene education. As
a result, Indonesia has the second highest number of open
defecators worldwide at 59 million, according to the 2013
update published by the WHO/UNICEF Joint Monitoring Program
(JMP), and lags substantially behind its peers in the region
in terms of access to sanitation. This field note presents
the achievements, learning and reflections that resulted
from implementing a large-scale sanitation program in East
Java, Indonesia and provides recommendations for future
initiatives aimed at increasing access to improved
sanitation globally. Show Less -

Access to improved sanitation is a major
concern in the Lao Peoples Democratic Republic. Only 63
percent of the population of the country had access to
improved sa... Show More +nitation facilities in 2010. Sanitation
conditions are worse in rural areas. This study aims to
generate evidence on the costs and benefits of sanitation
improvements Lao PDR. Show Less -

This paper includes the following
headings: scaling up rural sanitation and hygiene; creating
sustainable services through domestic private sector
participation; ta... Show More +rgeting the urban poor and improving
services in small towns; delivering Water and Sanitation
Sector (WSS) services in fragile states; and looking ahead
in East Asia and the Pacific for FY14-15. Show Less -

Effective management of sanitation and
wastewater is a growing challenge in dense urban
settlements. Rapidly increasing urbanization and, along with
that, rising se... Show More +ttlement densities in low-income urban and
peri-urban areas highlight the need for sanitation
technologies and management systems that are robust and
affordable, and which lessen the pollution load on local
water sources. In many developing countries, centralized
sewerage and wastewater treatment systems cover only a
portion of larger urban areas, and are often not yet planned
for smaller towns and densely populated, low-income areas of
cities. On-site sanitation is often inappropriate in the
denser settlements and slum areas, thus requiring
intermediate and complementary solutions. Decentralized
wastewater treatment systems (DEWATS) connected to
simplified sewer systems or communal sanitation centers have
the potential to close the gap between on-site and
centralized systems. Community-managed DEWATS offer the
possibility of swift sanitation improvements in high
priority neighborhoods that communities can manage
themselves, where local government does not yet provide a
full sanitation service. This review explores
Indonesia's experience in implementing
community-managed DEWATS on a growing scale, and more
specifically, whether community-managed DEWATS are a viable
urban sanitation option for serving poor households in dense settlements. Show Less -

The Water and Sanitation Program
(WSP)-supported Sanitation Marketing Pilot Project is one of
a range of sanitation marketing initiatives applying the
sanitation ma... Show More +rketing approach to the rural Cambodian
context. The project designed a new affordable pour-flush
latrine package (the 'Easy Latrine'), trained
local enterprises to profitably produce and sell it, and
developed sales and promotional strategies to increase
consumer demand. In less than two years, households from
four provinces purchased a total of 10,621 unsubsidized Easy
Latrines from local private enterprises. In 601 monitored
villages, there was a 7.7 percentage point increase in
improved sanitation coverage from a baseline of 24 percent,
which is six times higher than the background rate of
increase. Thus, a significant and rapid increase in durable
latrine coverage could be achieved without the use of any
hardware subsidies. Show Less -

In Lao People's Democratic Republic
(PDR), poor sanitation and hygiene causes at least three
million disease episodes and 6,000 premature deaths
annually. Diarrheal... Show More + disease is, in fact, tied with pneumonia
as the second largest killer of children under five. Poor
sanitation also contributes significantly to water
pollution, adding to the cost of accessing safe and clean
drinking water. The consequences go even further. A recent
study by the World Bank's Water and Sanitation Program
(WSP) found that in 2006, the country lost an estimated
LAK1.9 trillion (US$193 million) due to poor sanitation and
hygiene, equivalent to 5.6 percent of Gross Domestic Product
(GDP). Strengthening planning and accelerating progress in
sanitation and hygiene could yield substantial benefits, not
just for the economy but by prolonging life and improving
the future for the people of Lao PDR. In Laos, very little
information is available on how much money is being spent on
sanitation and hygiene, by which entities, for what
purposes, or in what locations. There is also little
information on who benefits from this expenditure. This
study aims to present an overview of the current status of
sanitation and hygiene financing and to provide useful
information and recommendations that can help strengthen
planning and accelerate progress in sanitation and hygiene.
This Research Brief summarizes the mains findings of the
study in Lao PDR. Show Less -

The Vietnam Handwashing Initiative (HWI)
began in January 2006 with the goal of reducing morbidity
and mortality from diarrheal diseases in children less than
five ... Show More +years of age. In December 2006, Vietnam became one of
four countries in the Water and Sanitation Program's
(WSP) Global Scaling Up Handwashing Project. The objective
of the project was to learn how to stimulate improved hand
washing behaviors at large scale, sustain the activities
after the project ended, and measure the impact on
behavioral, health, and welfare outcomes. This learning note
presents the achievements, learning, and reflections that
resulted from implementing a large-scale hand washing
program in Vietnam and provides recommendations for future
hygiene promotion initiatives. During the four-year
implementation (2006-2010), the program achieved all four of
its key objectives. However, a randomized control trial
(RCT) impact evaluation found no significant changes in hand
washing behavior and no impact on health in children under
two. Although much has been learned about how to implement a
nation-wide communication program in Vietnam, behavior
change at scale has proven challenging. Show Less -

This study evaluates the costs and
benefits of technical sanitation options and programs in
Yunnan Province, China, as part of the Economics of
Sanitation Initiativ... Show More +e (ESI) conducted by the World
Bank's Water and Sanitation Program in East Asia. As an
underdeveloped province, Yunnan has achieved huge progress
in sanitation improvement since the 1990s. Sanitation
options evaluated in the study include the facilities to
collect and convey human excreta, household wastewater
treatment, and related hygiene practices. The benefits of
sanitation evaluated include health, water quality, time to
access sanitation facilities, external environment, reuse of
human excreta, quality of life improvement, and other
intangible benefits such as privacy, cleanliness and
comfort. The costs of sanitation measured include investment
costs and recurrent costs (operations and maintenance). The
study compares the costs and benefits of alternative
improved sanitation options over the expected life of each
technology, to estimate efficiency of alternative sanitation
options. For the study sanitation options in eight different
sites throughout Yunnan Province were selected. Three rural
sites include: a) villages in Luquan countys mountainous
rural villages (R1); b) Dali Shangguan (R2) lakeside plain;
and c) villages in Qiubei county (R3). Three urban sites
represent: a) Kunming (U1); b) Dali (U2); and c) Qiubei
(U3). Two peri-urban sites include: a) Kunyang town of
Jinning County (PU1) and b) Dali Zhoucheng (PU2). The
economic returns on all improved sanitation options are
significant in all the sites evaluated, when compared with
no access to basic sanitation. Show Less -

This document presents the findings of a
study on sanitation finance in Cambodia conducted for the
Water and Sanitation Program (WSP) with support from the
Asian De... Show More +velopment Bank (ADB). The overall objective of the
assignment was to consider sustainable sanitation financing
options with a focus on promoting access for the poorest.
This guidance note contains an introduction on sanitation
financing and subsidies, stating the cases for subsidies as
well as some of their practical pitfalls. The study used
data (as of late 2009) from two case studies of rural
sanitation finance in Cambodia to illustrate the practical
issues, sup-plemented by preliminary data from two
sanitation marketing projects. The study also examined the
potential use and effectiveness of (hardware) subsidies,
conditional cash transfers (CCTs), and other financing
approaches relevant for sanitation improvement. The document
ends with recommendations for improved sanitation finance,
including practical suggestions for sanitation programs in
Cambodia. These recommendations bear particular relevance
for the ADB's Second Rural Water Supply and Sanitation
Sector Project, which commenced in 2010. Show Less -

The Vietnam Handwashing Initiative (HWI)
was launched in January 2006 by the Ministry of Health (MoH)
with funds from the Danish Embassy in Vietnam and technical
as... Show More +sistance from the Water and Sanitation Program (WSP). This
learning note documents the development process of the
caretakers' program with a focus on how it was
designed, implemented, and monitored. Lessons learned and
challenges are also highlighted to assist program managers
in designing and managing evidence-based handwashing with
soap or other hygiene promotion programs. A separate
publication will focus on the process of developing the
children's handwashing program. Show Less -

Statistics from the UN Joint Monitoring
Program show sanitation progress in Indonesia to be
off-track coverage has to increase by more than 13
percentage points nat... Show More +ionally from 2008 to 2015 to meet the
sanitation target of the Millennium Development Goals, which
the Government of Indonesia committed to in 2002. However,
after being a largely forgotten issue in the 15 years
following the Asian financial crisis of 1997-98, sanitation
is now receiving increasing attention from all levels of
government in Indonesia. Recently the Government of
Indonesia has made considerable efforts to mobilize
additional resources in order to finance the country's
needs for infrastructure projects. The purpose of the
Economics of Sanitation Initiative (ESI) is to promote
evidence-based decision making using improved methodologies
and data sets, thus increasing the effectiveness and
sustainability of public and private sanitation spending.
Better decision making techniques and economic evidence
themselves are also expected to stimulate additional
spending on sanitation to meet and surpass national coverage
targets. The specific purpose of the ESI phase two studies
is to generate robust evidence on the costs and benefits of
sanitation improvements in different programmatic and
geographic contexts in Indonesia, leading to information
about which are more efficient and sustainable sanitation
interventions and programs. Basic hygiene aspects are also
included, insofar as they affect health outcomes. Show Less -

The Philippines is well on its way to
achieving the sanitation target, which is part of a combined
drinking water and sanitation target within the Millennium
Develo... Show More +pment Goal (MDG). As of 2008, about 76 percent of its
population had access to improved sanitation facilities (JMP
2010). This is nearly 18 percentage points higher than the
estimates for 1990 and 3 percentage points short of the MDG
target for sanitation. This study aims to generate evidence
on the costs and benefits of sanitation improvements in
different contexts in the Philippines. Conducted with a view
towards identifying the most economically efficient options
under different conditions, it aims to contribute to the
decision making processes of government, donor agencies, and
non-governmental organizations (NGOs) and other
institutions. The study quantified the costs and benefits
associated with various sanitation options in different
study sites. The benefits included the impacts on health,
water sources and treatment, access time, and the reuse of
human excreta. The costs included capital or investment
costs and the recurrent costs associated with various
sanitation options. The costs and benefits of the sanitation
options were synthesized using standard indicators of
economic efficiency. These indicators included the
benefit-cost ratio, cost-effectiveness ratio, net present
value, internal rate of the return, and payback period of
sanitation options. Cost-effectiveness ratios cost per
disability life year averted, cost per disease case averted,
cost per death averted were also calculated. Show Less -

The book discusses basic concepts on key
topics to managing a small piped water system ideally for up
to 1,000 households. It presents tools that can be adapted
by ... Show More +Community-Based Water Organizations (CBOs) for use in
their operations, such as forms, checklists and procedural
guidelines. Illustrative examples have also been compiled
from the experiences of the district local governments,
support organizations and CBOs operating in East and West
Java, who participated in the Multi-Village Pooling (MVP)
Project. This toolkit seeks to compile a set of ready
resources for organizations supporting Indonesian CBOs and
CBOs themselves, which was not previously available despite
many years of rural water investment projects. The book
introduces fundamental concepts in an easy to-understand
way, so that a number of discussions have been simplified.
This will give users a basic understanding enough to seek
further resources or references or advice from experts,
which is encouraged. Show Less -

Vietnam and Peru are two of four
countries taking part in the Water and Sanitation Program
(WSP) Global Scaling up Handwashing Project. Funded by the
Bill and Melin... Show More +da Gates Foundation, the Global Scaling Up
Handwashing Project aims to expand handwashing practices
among women of reproductive age (15-49 years) and primary
school-aged children (5 to 12 in Peru; 6 to 10 in Vietnam)
The project focuses on applying innovative promotional
approaches to generate widespread and sustained improvement
in handwashing with soap practice. Started in December 2006,
the project is implemented by local and national governments
with technical support from WSP, and participation from the
private sector and nongovernmental organizations. The
present document describes the approaches to changing
children's handwashing with soap behavior, first in
Vietnam, then Peru, followed by some lessons learned and conclusions. Show Less -

The Economics of Sanitation Initiative
(ESI) is a multi-country study launched in 2007 as a
response by the World Bank's Water and Sanitation
Program to address maj... Show More +or gaps in evidence among developing
countries on the economic aspects of sanitation. Its
objective is to provide economic evidence to increase the
volume and efficiency of public and private spending on
sanitation. This research brief summarizes the key findings
of study second phase, cost-benefit analysis of alternative
sanitation options, from Indonesia. Show Less -

The Economics of Sanitation Initiative
(ESI) is a multi-country study launched in 2007 by the World
Bank's Water and Sanitation Program to address major
gaps in evi... Show More +dence among developing countries on the economic
aspects of sanitation. Its objective is to provide economic
evidence to increase the volumes and efficiency of public
and private spending on sanitation. This research brief
summarizes the key findings of study second phase,
cost-benefit analysis of alternative sanitation options,
from the Philippines. Show Less -